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72 Cards in this Set
- Front
- Back
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abandonment
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termination of care by emt without consent of patient or without making provisions for care of equal or greater value
Note: Provider may leave patients or delay treatment in equal or greater level of training... dangerous situations... |
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advance directive
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Specifies medical treatments desired if patient is unable to make decisions
• Do not resuscitate (DNR) orders • Living Will • Health Care Proxy • MOLST |
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assault
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unlawfully placing a patient in fear of bodily harm
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battery
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touching a patient or providing emergency care without consent
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competent
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able to make rational decisions about personal well-being
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consent
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Permission: a. To allow.
b. A formal written or oral order giving permission. |
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dependent lividity
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blood settling to the lowest point of the body, causing discoloration to the skin
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DNR
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(do not resuscitate orders) written documentation giving permission to medical personnel not to attempt resuscitation in the event of a cardiac arrest.
A patient with a valid DNR that goes into respiratory arrest will not be resuscitated DNR Orders may be printed on a NYS DOH approved form or on a Medic Alert bracelet. |
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duty to act
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• Individual’s responsibility to provide patient care.
• Responsibility to provide care comes from either statute or function. • Legal duty to act begins once an ambulance responds to a call or treatment is initiated. • Whenever you are on duty you have a duty to act! • No legal duty to act when off duty |
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expressed consent
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consent in which a patient gives express authorization for provision of care or transport
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forcible restraint
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the act of physically preventing an individual from any physical action
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good Samaritan laws
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statutory provisions enacted by many states protect citizens from liability for emergencies and omissions in giving good faith medical care, unless there is wanton, gross, or willful negligence.
Protects anyone that has NO training and who, in good faith, wishes to provide care to a sick or injured person. |
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implied consent
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The patient is not capable of giving actual consent.
Any unconscious patient. Any patient with an altered mental state. a. Intoxicated b. Drugs c. Diabetic Any pediatric patient needing medical care with no parent or legal guardian is present. Any mentally disabled patient that can’t make an informed decision. |
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informed consent
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Patient must be mentally competent. Must be of legal age Must be able to understand
a. What you think is wrong with them. b. What the treatment will be. c. Benefits of accepting treatment. d. The dangers of refusing treatment. e. Patient must be able to make a reasonable decision. f. Possible side effects of treatment. |
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medicolegal
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s term relating to medical jurisprudence (law) or forensic medicine
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negligence
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failure to provide the same care that a person with similar training would provide.
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precedence
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basing current action on lessons, rules, or guidelines derived from previous similar experiences
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putrefaction
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decomposition of body tissues
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rigor mortis
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stiffening of the body; a definitive sign of death
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standard of care
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accepted levels of care expected by reason of training; what other people with the same training would do in your situation
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scope of practice
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– Defined by state law
– Outlines care you can provide – Further defined in protocols and standing orders – Authorized through online and off-line medical direction |
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how standard of care is established
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Standard imposed by local custom
– Often based on locally accepted protocols Standard imposed by the law – May be imposed by statutes, ordinances, administrative guidelines, or case law Professional or institutional standards – Recommendations published by organizations and societies – Specific rules and procedures of your service or organization |
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bystander's responsibility to act?
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no obligation to act. if you are on duty, you have an obligation to act. wearing ems apparel and off duty: depends on the state. gray area.
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determination of negligence/ components of a lawsuit
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• In order to prove NEGLIGENCE, all of the following must be proven
1. There was a Duty to Act 2. There was a Breach of Duty 3. The patient condition worsened or was made worse 4. There was a cause or affect as result of the EMT’s action or inaction |
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breach of duty
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no breach of duty when the emt does not act within an expected and reasonable standard of care
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damages
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there are damages when a patient is physically or psychologically harmed in some noticeable way.
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cause
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a reasonable cause and affect. example: dropping a patient while lifting them and fracturing their leg.
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reason and requirements for expressed or actual consent
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the patient has the right to determine what is done with their body. The patient must be of legal age and rational mind.
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examples of implied consent
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patient is unconscious, delusional, unresponsive as a result of drug or alcohol abuse, or otherwise physically unable to give expressed consent.
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minors and consent
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parents have to give consent for treatment or transport. or if they are not there then it is implied. situations in which a minor can refuse:
1. emancipated 2. in military 3. married, pregnant or has given birth |
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how can refusal of medical care be implied?
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if a patient pulls away from you, puts their hands up in protection, or any other physical gesture.
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when can you physically restrain?
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if you believe the patient will injure themselves or others. but you must consult medical control for consent or contact law enforcement
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if a patient refuses medical assistance (rma)...
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you must inform them of the risks and what the benefits of treatment would be. also encourage them to ask questions. then you must document the refusal/and or written statement by the patient and have a witness (preferably besides your partner) and the witness's signature. generally try to persuade them gently and patiently.
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if parents refuse treatment of an injured child
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possibly need to report the situation as child neglect
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what if an rma refuses to sign?
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report to medical control and follow procedures
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types of advance directives
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1. comfort care order - specifies care a person should receive if they become incompetent
2. DNR - permission not to resuscitate |
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DNR orders requirements
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1. clearly state the patient's medical problems
2. be signed by patient or legal guardian 3. be signed by one or more physicians 4. if with expiration date, must be dated in the preceding 12 months to be valid Must be physically present. When in doubt Start CPR. You must always notify Medical Control for all DNR’s. |
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are you still required to give care with DNR's?
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yes you have to provide support measures such as oxygen, pain relief, and comfort to a patient who is not in cardiac arrest. you also still have to treat medical conditions that are unrelated to their DNR's (i.e. getting hit by a truck).
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confidentiality
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• Information received from or about a patient is considered confidential.
• Disclosing information without permission is considered a breach of confidentiality. • Generally, information can only be disclosed if the patient signs a written release. Except in automatic release which is when you are sharing information with other health care providers so they may continue the patient's care. |
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two rules the courts consider regarding reports and records:
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• Complete documentation is a safeguard against legal complications.
• If an action or procedure is not recorded, courts assume it was not performed. • An incomplete or untidy report is considered evidence of incomplete or inexpert care. |
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reporting injuries
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injuries committed during a crime, possibly drug-related injuries, childbirth, possibly attempted suicides, dog bites, certain communicable diseases, assaults, and rapes.
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what to do if helping a patient at the scene of a crime, also before the police arrive?
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take notes and sketches of patient, try not to cut holes through clothing, step carefully, do not use toilet, or touch many things in place.
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determination of the cause of death is...
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the medical responsibility of a physician
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exceptions to the rule that you should treat a body as alive at all times if it is warm and intact.
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1. in cases of hypothermia (under 86 degrees the patient can only survive without perfusion for about ten minutes): the patient should not be considered dead until dead and warm.
2.multiple presumptive signs of death 3. definitive signs of death |
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presumptive signs of death
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- unresponsiveness to painful stimuli
- lack of pulse or heartbeat -absence of breath sounds - no deep tendon or corneal reflexes - absence of eye movement - no systolic blood pressure - profound cyanosis - lowered or decreased body temperature |
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definitive signs of death
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- obvious mortal damage such as decapitation
- dependent lividity - rigor mortis - putrefaction |
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when must a medical examiner be notified?
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when trauma or a factor of death involves suspected criminal activity. this gives the coroner responsibility at the scene.
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example coroner cases:
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- doa's
- when the physician is not able to state cause of death - suicide - poisoning - accidents - suspicion of criminal activity |
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Standards Imposed by States
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• Certification
– Process of evaluating and recognizing that EMT-B has met certain predetermined standards – Certification done by NYS DOH BEMS. – Must be refresher every 36 months |
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Omission
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• Nonfeasance: - The EMT failed to perform his or her duty.
• Misfeasance: - The EMT performed an approved action IMPROPERLY. - Example: Patient is short of breath. You treat with low concentration oxygen. • Malfeasance: - The EMT performs a action above their level of training. |
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Gross Negligence
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Intentional harming of the patient.
An act of malice. Unreasonable action The desires to see someone hurt or injured |
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NYS DOH Article 30
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Provides protection to any person that is not being paid who renders care outside of a medical facility.
Generally governs ambulance systems. |
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liability
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legal responsibility
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plaintiff
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individual bringing suit
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defendant
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Individual being sued.
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false imprisonment
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Transporting a competent patient against their will.
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TORT
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Act that gives rise to a civil suit.
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For actual consent, EMT must:
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a. Identify who you are, and level of training
b. Identify who you work for c. Explain what you believe is wrong d. What your treatment will be e. The possible consequences of refusing treatment |
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Emancipated minor
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Anyone in the armed forces.
Anyone requesting treatment for sexual, physical, or drug abuse. Anyone seeking treatment for sexually transmitted disease. Anyone self-supporting and living on their own. A minor who has given birth to a child. |
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Suspected Child/Spouse/Elder Abuse
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• NYS Social Services law considers EMTs and AEMTs to be mandatory child abuse reporters.
CFR providers are not included in the law. • Failure to report suspected abuse may subject the EMT or AEMT to liability to civil or criminal prosecution |
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ABANDONED INFANT PROTECTION ACT
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• New York Social Service law states that infants 5 days or younger may be abandoned by their parents or caretaker in a safe location, such as a hospital, fire house, police station, ambulance or with an appropriate person
• Parents or caregivers may wish to remain anonymous • Does provide the parent or caregiver with an acceptable defense against prosecution for abandonment • Does not relieve the EMT of the responsibility to report abandonment to the NYS Central Register |
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Ethical Responsibilities
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• Make the physical/emotional needs of the patient a priority.
• Practice/maintain skills to the point of mastery. • Critically review performances. • Attend continuing education/refresher programs. • Be honest in reporting. |
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Health Care Proxy Law
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• Legal form
• Patient designates a person to make medical decisions on his or her behalf (“Agent”) • If there are any special instructions by patient, it is spelled out on this form • Form remains valid indefinitely • A copy remains with the Agent, and patient’s Doctor • EMT must treat any patient with a Health Care Proxy order. • Take a copy of the form to the hospital REMEMBER: Do not withhold any pre-hospital treatment! This is an example of an “Advanced Directive” |
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Living Will
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• Patient’s statement of desires or intentions regarding treatment or resuscitation
• Legal form (can be written on any paper) • Do not withhold any pre-hospital treatment • Take form or paper with the patient to hospital |
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MOLST
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Medical Orders for Life-Sustaining Treatment
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Pre-Hospital Care Report
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Must be completed whenever an ambulance responds to call
The patient is your responsibility until the patient is signed over to the receiving hospital. A completed PCR is a legal document. |
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what are the scope of care/scope of practice?
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a. Provide patient care
b. Work within your scope of training. c. Follow protocols. d. Follow medical control. |
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Stopping CPR
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Once CPR has been started by anyone:
CPR may NOT be stopped unless OLMC is contacted and approved of your decision to stop! |
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Part 800
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what is required to be on board an ambulance: has not changed since 1984
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Where can you find a CPR kit?
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By law, in every restaurant in NYC.
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What do you do if a baby or is abandoned or given to you?
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Accept him/her, take him/her to the hospital, report child abuse.
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What advance directives can you honor and which ones can you not?
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Can - DNR, MOLST
Cannot - health care proxy, living will |
